Biomedical subjects

Douglas P Gross

Publications and source records attributed to Douglas P Gross.

11 recordsLinked to original sources

PubMed2006

A population-based survey of back pain beliefs in Canada.

STUDY DESIGN: Population-based survey. OBJECTIVES: To assess the back pain beliefs in 2 provinces in Canada to inform a population-based educational campaign. SUMMARY OF BACKGROUND DATA: Beliefs, attitudes, and recovery expectations appear to influence recovery from back pain, yet prevailing public opinions about the condition have been little studied. METHODS: Telephone surveys were conducted with 2400 adults in 2 Canadian provinces. Surveys included the Back Beliefs Questionnaire, and additional questions concerning age, gender, recent and lifetime back pain, coping strategies for back pain, and awareness and persuasiveness of media information concerning back pain. RESULTS: A high prevalence of back pain was reported, with a lifetime prevalence of 83.8%, and 1-week prevalence of 34.2%. Generally, a pessimistic view of back pain was held. Most agreed that back pain makes everything in life worse, will eventually stop one from working, and will become progressively worse with age. Mixed opinions were observed regarding the importance of rest and staying active. A significant minority (12.3%) reported taking time off from work for their last back pain episode. Those individuals taking time off from work held more negative back pain beliefs, including the belief that back pain should be rested until it gets better. CONCLUSIONS: Public back pain beliefs in the 2 Canadian provinces sampled are not in harmony with current scientific evidence for this highly prevalent condition. Given the mismatch between public beliefs and current evidence, strategies for reeducating the public are needed.

Adolescent↗

PubMed2006

Development and validation of a short-form functional capacity evaluation for use in claimants with low back disorders.

OBJECTIVES: Functional Capacity Evaluations (FCE) are used for making return-to-work decisions, yet FCE's modest predictive ability is currently outweighed by the administrative burden of testing. We attempted to develop a short-form FCE while maintaining comparable predictive ability. METHODS: Three databases previously created for evaluating FCE predictive validity were used. Subjects were compensation claimants with low back disorders. FCE measures included items in the Isernhagen Work Systems' FCE. Days until benefit suspension served as an indicator of return-to-work. Analysis included Cox regression. RESULTS: Three items, floor-to-waist lift, crouching, and standing, were maintained in the short-form FCE. The short-form FCE was found to predict comparably to the entire FCE protocol in two validation cohorts (R (2) difference<3%). Subjects meeting job demands on all three items consistently experienced faster benefit suspension. CONCLUSION: A short-form FCE for determining future work status in claimants with low back disorders was developed. A substantially abbreviated FCE may offer an efficient alternative.

Canada↗

PubMed2006

Are functional capacity evaluations affected by the patient's pain?

Functional capacity evaluations (FCE) are comprehensive batteries of performance-based tests used commonly to inform return-to-work decisions for injured workers. As many people undergoing FCE have painful musculoskeletal conditions limiting their work ability, pain becomes a critical factor in the assessment of function. This paper considers the available literature related to the influence of pain on FCE, which clearly indicates FCEs are behavioral assessments influenced by pain intensity and other pain-related constructs. Increasing pain levels are consistently associated with reduced FCE performance levels. As such, for purposes of claims adjudication, FCE should not be considered a purely "objective" indicator of functional impairment independent of subject or evaluator perceptions. FCE may have some value for facilitating return-to-work or re-integrating chronically disabled workers into the workforce, although pain factors must be taken into consideration when making predictions about future work status. Shorter FCEs could potentially be as effective as more lengthy protocols.

Humans↗

PubMed2005

Predicting timely recovery and recurrence following multidisciplinary rehabilitation in patients with compensated low back pain.

STUDY DESIGN: Historical cohort study. OBJECTIVES: We investigated factors predictive of timely and sustained recovery following multidisciplinary rehabilitation in Workers' Compensation claimants with low back pain. SUMMARY OF BACKGROUND DATA: It is still unknown which factors predict better outcomes among back pain patients enrolled in intensive rehabilitation programs. Previously, few consistent predictors have been reported. METHODS: We created and tested predictive models using data from clinical and administrative databases of the Alberta Workers' Compensation Board. Predictive models were built on a cohort of subjects admitted for multidisciplinary rehabilitation in 1999 and tested on subjects admitted in 2000. Cox regression was used to evaluate days to time-loss benefit suspension and days to claim closure following admission for rehabilitation. Logistic regression was used to evaluate risk of future recurrence as judged through time-loss benefit resumption, claim reopening, or new back-related claims filing. RESULTS: Prediction models were variable between exploratory and confirmatory stages, and few variables were found to predict consistently. The number of preadmission healthcare visits was the most robust predictor of all recovery outcomes. Recurrence rates were 18% in 1999 and 22% in 2000. A higher number of preadmission healthcare visits and more previous back-related claims were associated with higher risk of recurrence. CONCLUSIONS: The number of preadmission healthcare visits was the most robust prognostic indicator with more healthcare visits related to delayed recovery and higher risk of recurrence. Recurrence rates following successful functional restoration were consistent with the episodic and recurrent nature of low back pain.

Adult↗

PubMed2005

Work-related recovery expectations and the prognosis of chronic low back pain within a workers' compensation setting.

OBJECTIVE: We examined the association between work-related recovery expectations and return-to-work in patients with chronic back pain. METHODS: A prospective cohort of workers receiving time-loss benefits for back pain of at least 6 weeks' duration was studied. Workers completed a battery of measures, including a work-related recovery expectations questionnaire. Outcomes included surrogate indicators of timely return-to-work (days until suspension of time-loss benefits) and recovery (claim closure) censored at 1 year. Analysis included multivariable Cox and logistic regression. RESULTS: The sample was predominantly male (63%), with a mean age of 42 years. Positive work-related recovery expectations predicted a 26% faster suspension of time-loss benefits (95% confidence interval = 8-40%) and explained 7% of the variation in this outcome. CONCLUSION: Recovery expectations provide important information for predicting time to return-to-work, as measured through suspension of time-loss benefits (R approximately 7%) in patients with chronic back pain.

Adult↗

PubMed2005

Factors influencing results of functional capacity evaluations in workers' compensation claimants with low back pain.

BACKGROUND AND PURPOSE: Physical and psychosocial factors are hypothesized to influence performance-based assessment. The purpose of this study was to evaluate the association between performance on the Isernhagen Work System Functional Capacity Evaluation (IWS-FCE) and various clinical and psychosocial factors. SUBJECTS: The sample consisted of 170 workers' compensation claimants who were undergoing functional capacity evaluations (FCEs) for low back injuries. METHODS: In this cross-sectional study, claimants completed a battery of work-related measures, including the IWS-FCE, the Pain Disability Index (PDI), a workplace organizational policies and practices scale, and a recovery expectations questionnaire. Functional capacity evaluation performance indicators were the number of tasks in which subjects did not meet work demands and weight lifted on the floor-to-waist lift. Analysis included multivariable regression. RESULTS: Only the PDI, pain intensity, age, and sex independently contributed to floor-to-waist lift performance. The PDI, pain intensity, and duration of injury contributed to the number of failed tasks. DISCUSSION AND CONCLUSION: The results indicate that performance on FCEs is influenced by physical factors, perceptions of disability, and pain intensity. However, perceptions of workplace organizational policies and procedures were not associated with FCE results for workers' compensation claimants with chronic back pain disability. Functional capacity evaluations should be considered behavioral tests influenced by multiple factors, including physical ability, beliefs, and perceptions.

Adult↗

PubMed2004

The prognostic value of functional capacity evaluation in patients with chronic low back pain: part 1: timely return to work.

STUDY DESIGN: Historical cohort study. OBJECTIVES: We examined the validity of the Isernhagen Work Systems' Evaluation in predicting timely return to work. SUMMARY OF BACKGROUND DATA: Functional Capacity Evaluations are used commonly to determine readiness for return to work, yet little is known of their validity. METHODS: Workers' compensation claimants undergoing Functional Capacity Evaluations following work-related low back injury were studied. Two cohorts were formed, one on which exploratory analyses were conducted and a second for confirmation. Evaluation indicators were the number of tasks in the protocol rated as failed and performance during the floor-to-waist lift task. The primary outcome investigated was time receiving total temporary disability benefits (as a surrogate of return to work) and a secondary outcome was time until claim closure in the year following Evaluation. Cox proportional-hazards regression was used to determine the prognostic effect of Evaluation crudely and after controlling for potential confounders. RESULTS: Few patients (4%) were found to pass all Evaluation tasks, yet most experienced total temporary disability suspension and claim closure within 1 year following Functional Capacity Evaluations. Better Evaluation performance was related to faster time to suspension of total temporary disability benefits and claim closure after controlling confounding factors, but explained little of the variation in these outcomes (approximately 10%). Performance on the floor-to-waist lift was as predictive as the number of failed tasks in the entire Functional Capacity Evaluations protocol. CONCLUSIONS: Better performance on Evaluation was weakly associated with faster recovery; however, the amount of variation explained was small. One task in the Evaluation was as predictive as the entire protocol.

Adult↗

PubMed2004

The prognostic value of functional capacity evaluation in patients with chronic low back pain: part 2: sustained recovery.

STUDY DESIGN: Historical cohort study. OBJECTIVES: We investigated the ability of the Isernhagen Work Systems' Functional Capacity Evaluation to predict sustained recovery. SUMMARY OF BACKGROUND DATA: Functional Capacity Evaluation is commonly used to determine readiness or ability for safe return to work following musculoskeletal injury, implying a low risk of future recurrence or "reinjury." However, this theoretical construct has not yet been tested. METHODS: Workers' compensation claimants who underwent Functional Capacity Evaluation following low back injury and subsequently demonstrated recovery in the form of suspension of total temporary disability benefits or claim closure were studied. The number of failed tasks and performance on the floor-to-waist lift task in the protocol were used as indicators of Functional Capacity Evaluation performance. Indicators of sustained recovery included whether or not total temporary disability benefits restarted, the claim was reopened, or a new back claim was filed. Logistic regression was used to determine the prognostic effect of Functional Capacity Evaluation alone and after controlling for suspected confounding variables. RESULTS: Overall, 46 of 226 patients (20%) experienced a recurrent back-related event within the year following Functional Capacity Evaluation. Opposite to the initial hypothesis, a lower number of failed Functional Capacity Evaluation tasks was consistently associated with higher risk of recurrence after controlling for potential confounding variables. Performance on the floor-to-waist lift task was not related to future recurrence. CONCLUSIONS: Contrary to Functional Capacity Evaluation theory, better Functional Capacity Evaluation performance as indicated by a lower number of failed tasks was associated with higher risk of recurrence. The validity of Functional Capacity Evaluation's purported ability to identify claimants who are "safe" to return to work is suspect.

Adult↗

PubMed2004

Measurement properties of performance-based assessment of functional capacity.

Performance-based functional assessments, including standardized functional capacity evaluation (FCE) batteries, are commonly used to determine the physical work abilities of individuals who have sustained musculoskeletal injury. The purpose of this paper is to critically examine research pertaining to the measurement properties of performance-based FCE, along with the theoretical bases for such measurement. While rater judgments of maximum performance during FCE appear reliable, FCEs do not appear to be purely tests of physical capacity as performance during assessment is influenced by multiple personal and environmental contextual factors. FCEs are more accurately considered behavioural tests influenced by multiple factors including physical ability, beliefs, and perceptions, and should be interpreted with in the subject's broader personal and environmental context.

Activities of Daily Living↗

PubMed2003

Construct validity of a kinesiophysical functional capacity evaluation administered within a worker's compensation environment.

The construct validity of a kinesiophysical Functional Capacity Evaluation (FCE) administered within a worker's compensation context was examined. A cross-sectional study design was employed. Clinical and demographic information on workers' compensation claimants was extracted from a rehabilitation facility's database. Measures of interest were the Isernhagen Work Systems' (Duluth, MN) FCE, the Pain Disability Index (PDI), and a pain visual analogue scale (VAS). A multitrait Pearson correlation matrix was created to observe the pattern of relationships between variables. The sample consisted of 321 subjects with work-related, medically stable low back pain of median duration of 307 days. FCE performance was moderately correlated with the PDI (r = -0.44-0.52) and with the pain VAS (r = 0.34-0.45). Pain intensity was correlated highly with the PDI (r = 0.79). The moderate relationship between FCE and the PDI supports the construct validity of FCE as a functional measure. However, kinesiophysical FCE performance was not unrelated to pain severity ratings as purported.

Chronic Disease↗

PubMed2002

Reliability of safe maximum lifting determinations of a functional capacity evaluation.

BACKGROUND AND PURPOSE: Functional capacity evaluations (FCEs) are measurement tools used in predicting readiness to return to work following injury. The interrater and test-retest reliability of determinations of maximal safe lifting during kinesiophysical FCEs were examined in a sample of people who were off work and receiving workers' compensation. SUBJECTS: Twenty-eight subjects with low back pain who had plateaued with treatment were enrolled. Five occupational therapists, trained and experienced in kinesiophysical methods, conducted testing. METHODS: A repeated-measures design was used, with raters testing subjects simultaneously, yet independently. Subjects were rated on 2 occasions, separated by 2 to 4 days. Analyses included intraclass correlation coefficients (ICCs) and 95% confidence intervals. RESULTS: The ICC values for interrater reliability ranged from.95 to.98. Test-retest values ranged from.78 to.94. DISCUSSION AND CONCLUSION: Inconsistencies in subjects' performance across sessions were the greatest source of FCE measurement variability. Overall, however, test-retest reliability was good and interrater reliability was excellent.

Adult↗